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SPEECH-LANGUAGE SERVICES IN EARLY INTERVENTION VS. PRESCHOOL: WHAT'S THE DIFFERENCE?

Updated: May 12, 2021


When I was a director of special education for a five-county group of school districts, my agency also provided therapists to two counties’ early intervention programs. Many parents had questions about why their child’s services had to change when they turned age three. This week’s post will describe differences between the two programs. Next week I’ll explain how the transition between programs is supposed to work for you and your child.


Children in the US have access to low-cost and no-cost speech and language services from birth through age 21. Birth to age three services are provided through each state’s early intervention program, and services for ages 3–21 are provided through your local school district.


Both programs receive federal funding through the law known as IDEA (Individuals with Disabilities Education Act) and each state must follow the rules outlined there. Early Intervention services are called Part C services, because that’s the part of IDEA that lays out those rules. School services are referred to as Part B, for the same reason.


Federal funds don’t come near to covering the full costs of these programs, so state and local funds make up the difference. That means each layer of agencies gets to put their spin on some extra rules. You’ll find that each state has different eligibility rules, and services can look quite different depending upon the county or school district where you live.


The following sections contrast key components of the two federal programs that all states and territories must follow. I’ve included links to sections in the federal rules so you can check the details for yourself. One of my pet peeves is when people start paraphrasing the rules and it turns into a game of telephone—the information strays farther and farther away from accurate.


PURPOSE

Early Intervention

Early Intervention provides services that help families enhance the development of their child with a developmental delay or disability. Some children may be identified shortly after birth when they have a condition with a high likelihood of developmental issues, for example cerebral palsy or a genetic condition. Other children may be identified at age 1 or 2 when we see their development is significantly slower than the expected rate.


Preschool

Preschool programs provide a "free appropriate public education" (FAPE) to children with disabilities. This mission includes two terms that have a special meaning under the law. The term disability means the child has a significant delay and won’t be able to benefit enough from their education program unless they receive specialized instruction. FAPE means that the child’s program is sufficient to allow them to make adequate progress in their education program and is provided at no cost to the parent.


COST

Early Intervention

States have flexibility in how they charge families for infant-toddler early intervention. Some states do not charge at all. Many charge a fee, which may or may not be based on family income.


Preschool

All school-based programs are required to be at no cost to families. This includes any related service (transportation, for example) that is required so the child can access their special program.


When a preschool child qualifies for speech-language services but not a preschool classroom program, parents usually are expected to transport their child to the therapy sessions. That’s fine, but usually parents are not informed that they can request to be paid mileage costs for this transportation. I’ve heard that some districts deny the request, and I don’t understand how they get around the federal rule. It never hurts to ask for reimbursement, and ask them to explain the reasoning if your request is denied.


Note: When I say “ask the school” I mean ask an administrator. Teachers and therapists are not authorized to okay an expense, so they are usually unfamiliar with the rules.


ELIGIBILITY

Both early intervention and preschool programs require an evaluation process to determine (1) if the child qualifies for services and (2) if yes, what services should be provided. The evaluation must be completed by a multidisciplinary team. This means at least two people must have a role in the evaluation and they must have different specialty knowledge.


Early Intervention

Testing must be completed within 45 days of a written referral. A meeting is then held to decide if services are needed.


Infants and toddlers qualify for early intervention services in two main ways:


(1) They have a developmental delay in one or more areas of development: cognitive, physical (including vision and hearing), communication, social or emotional, and adaptive (self-help). The amount of delay (usually measured by test scores) is defined differently by each state, as summarized here.


(2) They have a diagnosed physical or mental condition that has a high probability of resulting in a developmental delay. This may include conditions like chromosomal differences, genetic or congenital disorders, sensory impairments, disorders of metabolism or nervous system, an infection at birth, severe attachment disorder, or disorders related to exposure to toxic substances.


It’s important to remember that a child does not have to qualify with test scores if they have one of those diagnosed physical or mental conditions in item 2 above! Prevention of delays is the top priority here.


A special rule that is often overlooked allows for an interim treatment plan to be started before an evaluation is completed. This can be done if parents approve and it’s clear that the child and family need immediate services. Evaluations must still be completed within 45 days of the referral for services.


Preschool

Testing must be completed within 60 days of a written referral. A meeting is then held to decide if services are needed.


Children qualify for preschool services when they have a significant delay in one or more developmental categories. Significant delay is defined differently by each state, but relies heavily on test scores. The state rules might be understood differently in school districts, so you’ll sometimes see differences within a state.


The federal categories to be eligible for special education are: intellectual disability, hearing impairment including deafness, speech or language impairment, visual impairment including blindness, emotional disturbance, orthopedic impairment, autism, traumatic brain injury, other health impairment, specific learning disability, deaf-blindness, or multiple disabilities.


There’s a special disability category — developmental delay — that’s used only for preschoolers. Preschoolers may be in this category if they have a measured delay in one or more of these developmental areas: physical, cognitive, communication, social-emotional or adaptive. Each state has an age where the child must qualify in one of the other categories in order to continue with special education services. The age can vary but state but may never be past nine years.


IMPORTANT DETAIL: In addition to qualifying (with scores) in a disability area, the team must document that the child requires special education because of that disability. In other words, they won’t make adequate progress if they don’t get specialized instruction. If they can make adequate progress in school, they don’t require special education.


SERVICE PLAN

Early Intervention

A team develops an Individualized Family Service Plan (IFSP). The IFSP team includes a parent, members of the evaluation team, other people with specialized knowledge of the child, and anyone the parent says they want to invite.


The IFSP team relies on parent preferences to decide which of the identified needs will be included in the plan. This reflects the mission of supporting parents in their efforts to enhance their child’s development. The IFSP describes the outcomes the team wants to see for the child and family members, along with the services and supports that will be used to reach the outcomes. The timeline for meeting these outcomes is decided, along with a plan for measuring and reporting progress. A complete list of required components is here.


Progress on the IFSP must be reviewed at least every six months to see how things are going and if adjustments are needed to the plan. This 6-month review may be done with a meeting or other method the parent agrees to. A meeting must also be held at least once per year to update the child’s progress and make adjustments to the plan.


Preschool

A team develops an Individualized Education Plan (IEP). The IEP team must include a parent, a general education teacher, a special education teacher, and a representative of the school district who is familiar with the special and general education programs and is authorized to commit resources. If testing was done, someone on the team must be able to interpret the results. The parent or school may invite others who have knowledge or special expertise regarding the child. When appropriate, the child is part of the team.


As a school-based program, the IEP does not address supports for families. Parents are members of the IEP team and parent concerns must be considered, but the team is not required to make parent preferences a priority. This reflects the change in focus from a toddler’s typical learning environment (home) to an academic learning environment (school).


Contents of the IEP include goals that will allow the child to make progress in age-appropriate academic and functional skills. This includes a description of how progress will be measured and reported to parents. The IEP describes the type, amount and frequency of services to be provided, as well as modifications and supports needed in the general education setting.


IEP services fall into two categories: special education and related services. Special education means specially designed instruction that is provided at no cost to the parent and is designed to help the child access the general curriculum (in preschool, this includes age-appropriate developmental skills) and meet expected achievement standards.


Related service means any service the child needs so they can benefit from their specially designed instruction. This may includes but isn’t limited to things like nursing services; occupation, physical and speech-language therapy; counseling; transportation; and parent counseling or training.


Speech-language services can be either special education or a related service. When the child meets the state’s eligibility criteria for a speech-language disability, speech-language is special education and has a goal on the IEP. If the child qualified for special education under a different category, they may receive speech-language as a related service if it’s needed for them to be successful in their special education program.


A related service does not need to have a goal that is unique to that specialty. The IEP team needs to be able to identify which IEP goal(s) the related service is supporting. A nursing service, for example, might make it possible for the student to participate in all their special education goals. Speech-language as a related service might, for example, address language skills needed for achieving a reading comprehension goal.


An IEP meeting must be held at least once per year. Schools must make special efforts to make sure the parent can participate. Schools are allowed to go ahead with the meeting if a parent refuses to participate after repeated efforts to involve them. At the meeting, the IEP team reviews progress, new goals are established and other needed changes are made.


At least every three years there must be a re-evaluation to decide if the child continues to have a disability that requires specialized instruction. The re-evaluation can be skipped if both the parent and school decide it’s not necessary. A new IEP must always be written within 30 days of a re-evaluation.


LOCATION OF SERVICES

Early Intervention

There’s a strong preference for infants and toddlers to receive services in their natural environments. This means settings that are typical for a same-age peer without a disability. It may include the home or a community setting, and must be agreed upon by the parent and IFSP team.


Preschool

There’s a strong preference for keeping children in the least restrictive environment, meaning they are participating with their peers in their typical settings. The IEP team needs to balance a child’s need for specialized instruction with the need for participating with non disabled peers in academic and nonacademic activities. The team is required to describe the extent to which the child will not be participating with non disabled children in the regular class setting and explain why that is required for the specialized services to be effective.


Note that the law does not require complete inclusion with peers. Even though inclusion is highly valued, IEP teams are allowed to remove a child to a separate location if there is a valid, child-specific reason documented in the IEP. This policy letter lays out a full description of the preference for inclusion and the range of options that may be considered for providing services to preschoolers. The policy letter includes this summary: "Therefore, in determining the placement for a child with a disability who already participates in a regular public preschool program, the placement team must consider whether the LEA, in collaboration with the regular public preschool program, can ensure that the child receives all of the special education and related services and supplementary aids and services included." This means if a typical child has publicly-funded preschool option like Head Start, Early Head Start or 4-year-old kindergarten, the district must first consider how services could be provided in that setting. In addition, if no publicly-funded preschool program is available and the child is already participating in a private preschool or daycare, the district must consider if that is the least restrictive environment for the child to receive services.


CONCLUSION

There are many more details included in Parts B and C of IDEA, but these are some highlights that come up most often. You just got early intervention figured out and now you’re getting thrown into a whole new maze of paperwork and rules. It can be confusing and sometimes frustrating to navigate the new system. Don’t be afraid to ask for a one-to-one phone call or meeting with someone at the school so they can help you figure out what’s going on. You don’t need to go into your any meeting unprepared.


Next week: How to ease the transition between early intervention and preschool special education

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Joyce is very knowledgeable. Not only as a speech therapist but also on how the school system works. Which is very helpful going through the IEP process. She was able to engage with my daughter and was never hesitant to help in any way. I would definitely recommend Joyce to anyone that is looking for a trustworthy, caring and informed speech therapist.

- AUTUMN MARSHALL, PARENT